Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
601-617
Pneumonia complicated by
inuenza type A in a pediatric patient:
a case report
Neumonía complicada por Inuenza tipo A en
paciente pediátrico: un reporte de caso
Bertha Fabiola Riera Chérrez 1, Ana Isabel Chávez Arévalo 2,* Diana Stefanía Alcivar Aveiga 3
1 Postgraduate in Pediatrics at the Roberto Gilbert Children’s Hospital, Guayaquil Charity Board;
mdfabiolariera@gmail.com, Guayaquil, Ecuador.
2 Postgraduate in Pediatrics at Roberto Gilbert Children’s Hospital, Guayaquil Charity Board;
izachavez_19@hotmail.com, Guayaquil, Ecuador.
3 Specialist in Pediatrics at Roberto Gilbert Children’s Hospital, Guayaquil Charity Board;
dalcivara@jbgye.org.ec, Guayaquil, Ecuador.
How to cite:
Riera Chérrez, B. F., Chávez Arévalo, A. I., & Alcivar Aveiga, D. S. (2025). Pneumonia complicated by inuenza
type A in a pediatric patient: a case report. Multidisciplinary Journal of Contemporary Research, 3(2). 601-617.
https://doi.org/10.58995/redlic.rmic.v3.n2.a140
Article Information
Received: 07-03-2025
Accepted: 16-06-2025
Published: 01-07-2025
Editor’s Note
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claims in published messages and institutional
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Editorial
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Research (REDLIC)
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Funding Sources
The research was conducted using the authors’
own resources.
Conicts of Interest
No conicts of interest are declared.
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Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 49 -49
Copyright (c) 2025 Faicán Rocano Pedro Fernando, Dután Pérez Ibelice Salomé,
González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-
dugo Alejandra Valentina.
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Clinical case. Revista Multidisciplinaria Investigación Contemporánea.
Vol. 3 - No. 2, pp. 601 - 617. July-December, 2025. e-ISSN: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 32 -49
Artículo Caso clínico. Revista multidisciplinaria investigación Contemporánea.
Vol. 3 - No. 2, pp. 32 - 49. julio-diciembre, 2025. e-ISSN: 2960-8015
Leucemia de células dendríticas
plasmocitoides - estudio y diagnóstico
de un caso
Leucemia de células dendríticas plasmocitoides - estudio y
diagnóstico de un caso
Información del artículo:
Recibido: 05-12-2024
Aceptado: 21-02-2025
Publicado: 01-07-2025
Nota del editor:
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reclamos jurisdiccionales en mensajes publi-
cados y aliaciones institucionales.
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Conictos de interés:
No presentan conicto de intereses.
Este texto está protegido por una licencia Creative Commons 4.0.
Usted es libre para Compartir —copiar y redistribuir el material en cual-
quier medio o formato— y Adaptar el documento —remezclar, transformar
y crear a partir del material— para cualquier propósito, incluso para nes
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1 Docente Investigador; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.
2 Estudiante; ibelice.dutan.44@est.ucacue.edu.ec. Azogues, Ecuador.
3 Estudiante; camila.gonzalez.66@est.ucacue.edu.ec. Azogues, Ecuador.
4 Estudiante; joselyn.matute.44@est.ucacue.edu.ec. Azogues, Ecuador.
5 Estudiante; alejandra.rodriguez.60@est.ucacue.edu.ec. Azogues, Ecuador.
Faicán Rocano Pedro Fernando 1, Dután Pérez Ibelice Salomé 2, González González Camila
Raquel 3, Matute Aguiar Joselyn Nayeli 4, Rodríguez Verdugo Alejandra Valentina 5
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Cómo citar:
Faican Rocano, P. . F., Dután Pérez, I. S. ., González González, C. R. ., Rodríguez Verdugo, A. V. ., & Matute Aguiar, J.
N. . (2025). Leucemia de células dendríticas plasmocitoides - estudio y diagnóstico de un caso.
Revista Multidisci-
plinaria Investigación Contemporánea
, 3(2), 32-49. https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
602-617
1.1. Summary
Community-acquired pneumonia is a common cause of hospitalization in
children and can be aggravated by viral infections such as inuenza A. We present
the case of a four-year-old female patient with no relevant medical history who
was admitted with persistent fever, productive cough, and progressive respiratory
distress. Imaging studies showed a collapsed left lung and loculated pleural
effusion; inuenza A was conrmed by nasopharyngeal swab. Due to the lack of
clinical response to conventional medical treatment, a thoracotomy with left lower
lobectomy was performed. The surgical nding revealed pulmonary necrosis
and abundant brin. The postoperative course was favorable, with resolution of
the respiratory symptoms and successful removal of the chest drain. This case
highlights the importance of considering timely surgical intervention in pediatric
patients with pneumonia complicated by inuenza who do not respond to initial
medical management.
Keywords: Pneumonia; Inuenza type A; Pediatrics; Lobectomy; Pleural
effusion.
1.2. Abstract
Community-acquired pneumonia is a common cause of hospitalization in
children and can worsen due to viral infections such as inuenza A. We report
the case of a four-year-old female patient with no relevant medical history who
presented with persistent fever , productive cough , and progressive respiratory
distress . Imaging studies revealed left lung collapse and a loculated pleural
effusion ; nasopharyngeal swab conrmed inuenza A infection . Due to poor
clinical response to medical treatment , a thoracotomy with left lower lobectomy
was performed . Intraoperative ndings revealed pulmonary necrosis and
abundant brin . Postoperative recovery was favorable, with improvement of
respiratory status and successful removal of the chest drain . This case highlights
the importance of early surgical intervention in pediatric patients with complicated
pneumonia due to inuenza who fail to improve with conventional medical
management .
Keywords : Pneumonia ; Inuenza A; Pediatrics Lobectomy ; Pleural effusion.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
603-617
1. Introduction
Community-acquired pneumonia (CAP) remains one of the leading
causes of hospitalization and mortality in children worldwide, accounting
for approximately 15% of all deaths in children under ve years of age,
especially in low- and middle-income countries (1). This condition can
be aggravated by viral infections, with inuenza A virus being one of the
main agents involved in severe respiratory conditions in children (2).
Inuenza A causes an acute respiratory illness that can progress
to complications such as necrotizing pneumonia, pleural effusion, lung
abscess, and acute respiratory distress syndrome (ARDS) (3,4). Although
most cases are self-limited, a subgroup of patients develops severe
pneumonia, requiring prolonged hospitalization, advanced ventilatory
support, and, in exceptional situations, thoracic surgery (5).
Current evidence describes that bacterial coinfection, dysregulated
inammatory response and destruction of the pulmonary parenchyma
can lead to pulmonary necrosis, a situation that compromises the efcacy
of conventional medical treatment (6). In these cases, lobectomy can be
a safe and effective therapeutic alternative, especially when there is a
poor clinical response or the presence of pneumatoceles and abscesses
(7). Recent studies highlight that severe respiratory infections due to
inuenza have increased their incidence in post-pandemic contexts , and
that their management requires a multidisciplinary approach to improve
patient prognosis(8).
In Latin America, case reports documenting the clinical course of
pediatric patients with pneumonia complicated by in󰤱uenza A are scarce,
and those describing surgical interventions such as lobectomy are even
more limited. This underscores the importance of presenting clinical
experiences that can enhance therapeutic approaches in similar contexts.
(9).
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
604-617
In this context, this article aims to describe the clinical case of a
four-year-old pediatric patient with community-acquired pneumonia
complicated by inuenza A, which progressed to pulmonary necrosis
and required a left lower lobectomy. This article aims to contribute to the
available clinical evidence and highlight the importance of early diagnosis
and timely intervention in these cases.
2. Clinical case
A 4-year-old female pediatric patient with a complete vaccination
schedule presented to the pediatric emergency department with persistent
fever of 13 days’ duration. The initial symptom was unspecied fever
associated with a dry cough that progressed to a productive cough, mild
headache, and episodes of diarrhea two to four times a day, with no mucus
or blood present. Two to three episodes of vomiting were also reported in a
24-hour period. In the 72 hours prior to admission, the patient experienced
increasing respiratory distress, prompting the mother to seek hospital
consultation.
On admission, vital signs showed: temperature of 39.5°C, respiratory
rate of 52 rpm, heart rate of 170 bpm , oxygen saturation of 98% with
evident respiratory distress. A Woods Downes score of 6 was obtained.
Physical examination revealed semi-moist mucous membranes, subcostal
to supraclavicular retractions, and decreased breath sounds with the
presence of transmitted rhonchi. Immediate management was initiated
with oxygen through corrugated hose, peripheral cannulation, and
intravenous paracetamol administration at 15 mg/kg/dose as required.
Initial laboratory tests included a chest x-ray that revealed complete
opacity of the left lung eld with right mediastinal shift. Thoracic
ultrasound showed a loculated left pleural effusion with an estimated
volume of 181 cc. Chest computed tomography (CT) conrmed left lung
collapse with pneumatoceles, pleural effusion, and signs of bilateral
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
605-617
interstitial inltrate. Laboratory studies showed leukocytosis (28,790/
mm³), neutrophilia, elevated C-reactive protein (CRP), and a positive
detection of in󰤱uenza A virus by nasopharyngeal swab. Tuberculosis was
ruled out by PPD, pleural uid cultures, and gastric aspirate.
The patient was diagnosed with pneumonia complicated by
in󰤱uenza type A, associated with loculated pleural effusion and collapsed
left lung. Treatment was initiated with high-ow oxygen therapy, initially
at 15 L/min with an FiO2 of 50%, progressively adjusted according to
saturation. Ceftriaxone was administered at 100 mg/kg/day divided into
two doses and clindamycin at 30 mg/kg/day every 8 hours intravenously.
Antipyretic support was maintained with paracetamol every 6 to 8 hours
if the temperature was greater than 38.5 °C. Additionally, moderate uid
restriction, strict monitoring of urine output, and electrolyte control were
indicated.
Due to the persistence of fever, the deterioration of respiratory status
and the imaging ndings compatible with left lung collapse, loculated
pleural effusion and presence of pneumatocele, surgical intervention
was decided on the third day of hospitalization. Left thoracotomy with
resection of the lower lobe (lobectomy) and placement of a chest tube
for drainage, during the procedure extensive pulmonary necrosis and
abundant brin were observed.
The patient was transferred to the Pediatric Intensive Care Unit
(PICU) for close postoperative monitoring, where she received a red
blood cell transfusion for postoperative anemia and high-ow oxygen
therapy. The intravenous antibiotic regimen was continued for a total of
21 days. Postoperative management included monitoring of vital signs,
pleural drainage monitoring, multimodal analgesia with dipyrone and
paracetamol, uid balance monitoring, periodic evaluation with imaging
and laboratory studies, and pain control with intercostal block in the
operating room. During her stay, she showed progressive improvement in
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
606-617
respiratory and inammatory parameters, allowing for the removal of the
drainage tube on the fth postoperative day.
Her evolution during the 21 days of hospitalization was favorable.
Before discharge, the patient was hemodynamically stable, neurologically
alert, with preserved mobility, oriented, with no signs of respiratory
distress. The right lung eld was well ventilated and the left was slightly
hypoventilated. The chest tube wound was healing, and she performed
Triow (incentive spirometer) breathing exercises every 4 hours, with
good oral tolerance and no abdominal warning signs. Control laboratory
tests showed leukocytes: 6.78 x10³/mm³, neutrophils: 41%, lymphocytes:
39%, hemoglobin: 11.7 g/ dL , hematocrit: 33.8%, platelets: 447 x10³/mm³
and CRP: 3.69 mg/L. The biopsy revealed a brin -leukocyte exudate with
no stroma, granulomas, or pathogens. The follow-up echocardiogram
was normal, with no pericardial effusion. The patient did not experience
any further fever spikes and maintained good respiratory progress. She
was discharged from the hospital with follow-up care by specialists and
outpatient pediatricians, pulmonology, infectious disease, and pediatric
surgery. She was also instructed to perform home breathing exercises and
antireux treatment. The mother was instructed regarding warning signs
and home care.
2.1. Figures, Tables and Diagrams
Table 1.
Auxiliary examinations performed on the patient
LABORATORY TESTS ADMISSION RESULT REFERENCE VALUE
LEUKOCYTES (/UL) 22,800/ uL 4,000 - 10,000/ uL
NEUTROPHILS (%) 76.1% 40 - 75%
LYMPHOCYTES (%) 12.3% 20 - 45%
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
607-617
HEMOGLOBIN (G/DL) 8.4 G/DL 11.5 - 15.5 G/DL
HEMATOCRIT (%) 24.2% 34 - 44%
PLATELETS (/MM³) 750,000 MM³ 150,000 - 450,000 MM³
C-REACTIVE PROTEIN -
CRP (MG/DL)
268 MG/DL < 5 MG/DL
PROCALCITONIN - PCT
(MG/DL)
1.13 MG/DL < 0.5 MG/DL
BLOOD CULTURE CUL-
TURE
No growth -
URINE CULTURE No growth -
TUBERCULOSIS (PPD,
PCR, CULTURE)
Non-reactive -
INFLUENZA TYPE A
SWAB
Positive -
RSV / COVID-19 SWAB Negative -
ECHOCARDIOGRAM - -
CATHETER CULTURE No growth -
CATHETER GRAM No growth -
BIOPSY - -
Laboratory Test Control Result Reference Value
Leukocytes (/ uL ) 6,780 4,000 - 10,000 / uL
Neutrophils (%) 41% 40 - 75%
Lymphocytes (%) 39% 20 - 45%
Hemoglobin (g/ dL ) 11.7 g/ dL 11.5 - 15.5 g/ dL
Hematocrit (%) 33.8% 34 - 44%
Platelets (/mm³) 447,000 mm³ 150,000 - 450,000 /mm³
C-reactive protein (CRP,
mg/ dL )
3.69 MG/DL < 5 mg/ dL MG/DL
Echocardiogram Normal Without pericardial effusion
Biopsy brin exudate , without granu-
lomas or pathogenic microor-
ganisms
-
Source: prepared by the author (2024)
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
608-617
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
Neumonía complicada por Inuenza tipo A en paciente pediátrico:
un reporte de caso 608 - 617
Figura 1. Radiografía de tórax en proyección posteroanterior (AP) que evi-
dencia imagen de consolidación homogénea en el hemitórax izquierdo, con
desplazamiento de la tráquea y mediastino hacia la derecha. Se observa bo-
rramiento del ángulo costodiafragmático izquierdo, área cardíaca dentro de
límites normales y senos costofrénicos derechos libres. Estos hallazgos son
compatibles con derrame pleural izquierdo de volumen moderado a severo.
Figura 2. Ecografía pleural que evidencia derrame pleural izquierdo de vo-
lumen moderado, estimado en 181 cc, con presencia de múltiples tabiques
y septos en su interior. No se observaron detritos ni líquido libre en la cavi-
dad pleural derecha. Hallazgos compatibles con derrame pleural tabicado
izquierdo.
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
Neumonía complicada por Inuenza tipo A en paciente pediátrico:
un reporte de caso 608 - 617
Figura 1. Radiografía de tórax en proyección posteroanterior (AP) que evi-
dencia imagen de consolidación homogénea en el hemitórax izquierdo, con
desplazamiento de la tráquea y mediastino hacia la derecha. Se observa bo-
rramiento del ángulo costodiafragmático izquierdo, área cardíaca dentro de
límites normales y senos costofrénicos derechos libres. Estos hallazgos son
compatibles con derrame pleural izquierdo de volumen moderado a severo.
Figura 2. Ecografía pleural que evidencia derrame pleural izquierdo de vo-
lumen moderado, estimado en 181 cc, con presencia de múltiples tabiques
y septos en su interior. No se observaron detritos ni líquido libre en la cavi-
dad pleural derecha. Hallazgos compatibles con derrame pleural tabicado
izquierdo.
Figure 1. Posteroanterior (PA) chest radiograph showing a
homogeneous consolidation in the left hemithorax, with rightward
displacement of the trachea and mediastinum. Blurring of the left
costodiaphragmatic angle, cardiac area within normal limits, and free
right costophrenic sinuses are observed. These ndings are consistent
with moderate to severe left pleural effusion.
Figure 2. Pleural ultrasound revealed a moderate-volume left
pleural effusion, estimated at 181 cc, with multiple partitions and septa
within the pleural cavity. No debris or free uid was observed in the right
pleural cavity. These ndings were consistent with a left loculated pleural
effusion.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
609-617
Revista multidisciplinaria
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
Neumonía complicada por Inuenza tipo A en paciente pediátrico:
un reporte de caso 609 - 617
Figura 3A. Tomografía computarizada (TAC) de tórax en reconstrucción co-
ronal (Figura 3A). Se conrma el colapso del lóbulo inferior izquierdo, con
desplazamiento del mediastino y tráquea hacia la derecha. Se identican
inltrados intersticiales y reticulares bilaterales, con predominio en el lado
izquierdo. No se observan adenomegalias ni cavitaciones anómalas. Tomo-
grafía computarizada (TAC) de tórax en corte axial (Figura 3B). Se eviden-
cia colapso pulmonar del lóbulo inferior izquierdo, con consolidación densa
y pérdida de volumen pulmonar. Se observan neumatoceles y áreas de ne-
crosis en el parénquima afectado. El derrame pleural izquierdo de volumen
moderado desplaza el parénquima pulmonar adyacente. El campo pulmonar
derecho muestra inltrados intersticiales sin evidencia de derrame pleural.
Figure 3A. Coronal reconstruction of the chest computed
tomography (CT) (Figure 3A) . Collapse of the left lower lobe is conrmed,
with shift of the mediastinum and trachea to the right. Bilateral
interstitial and reticular inltrates are identied, predominantly on the
left side. No anomalous lymph nodes or cavitations are observed. Axial
section of the chest computed tomography (CT) (Figure 3B). Collapse of
the left lower lobe is evident, with dense consolidation and loss of lung
volume. Pneumatoceles and areas of necrosis are observed in the affected
parenchyma. The moderate-volume left pleural effusion displaces
the adjacent lung parenchyma. The right lung eld shows interstitial
inltrates without evidence of pleural effusion.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
610-617
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
Neumonía complicada por Inuenza tipo A en paciente pediátrico:
un reporte de caso 610 - 617
Figura 4. Radiografía portátil de tórax en proyección anteroposterior (AP)
que muestra área cardíaca dentro de límites normales, senos costofrénicos
libres y altura adecuada de ambas hemidiafragmas. Se observa acentuación
del intersticio pulmonar con presencia de inltrados perihiliares bilaterales,
sin evidencia de derrame pleural ni desplazamiento mediastinal. Se identi-
ca tubo de drenaje pleural izquierdo correctamente posicionado.
Figura 5. Radiografías prealta postero anterior (AP) (Figura 5A) y lateral de
tórax (Figura 5B) que muestran imagen de consolidación en el hemitórax iz-
quierdo, con inltrado alveolar denso, borramiento del ángulo costodiafrag-
mático e izquierdo y elevación del hemidiafragma ipsilateral.
Figure 4. Portable chest radiograph in anteroposterior (AP)
projection shows a cardiac area within normal limits, free costophrenic
sinuses, and adequate height of both hemidiaphragms. Accentuation of
the pulmonary interstitium is observed with the presence of bilateral
perihilar inltrates , with no evidence of pleural effusion or mediastinal
shift. A correctly positioned left pleural drainage tube is identied.
Figure 5. Pre-discharge posteroanterior (AP) (Figure 5A) and
lateral chest radiographs (Figure 5B) showing an image of consolidation
in the left hemithorax, with dense alveolar inltrate, effacement of
the costodiaphragmatic and left angle, and elevation of the ipsilateral
hemidiaphragm.
Figura: 5A
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
611-617
3. Discussion
Community-acquired pneumonia remains a leading cause of
hospitalization and childhood morbidity and mortality, with potentially
serious complications such as pleural effusion, pulmonary necrosis,
and pneumatocele formation (1). In󰤱uenza type A infection , recognized
for its high dissemination capacity and respiratory tract involvement,
is associated with an increased risk of bacterial superinfection and
progression to severe conditions (10).
In the case presented, the patient developed pneumonia complicated
by loculated pleural effusion and pulmonary necrosis, which required
medical and surgical management. These manifestations are consistent
with those described in recent studies, where coinfection with in󰤱uenza
A and bacterial agents such as Staphylococcus aureus (Staphylococcus aureus)
is suspected. aureus or Streptococcus pneumoniae increases the severity of
the clinical picture (11). The persistence of fever, lack of response to
empirical antibiotic therapy and radiological ndings of lung collapse
and pneumatoceles justied the indication for lobectomy, following
recommendations in the literature for refractory cases (12).
Although most complicated pneumonias in pediatrics resolve
with medical treatment, a subgroup requires surgical intervention.
A multicenter study reported that up to 5% of pediatric patients with
necrotizing pneumonia progress to procedures such as lobectomy,
especially in the presence of persistent sepsis, extensive lung destruction,
or organizing empyema (13). The decision for surgical intervention in this
case was based on radiological progression and clinical deterioration,
which is consistent with these recommendations.
However, diagnostic limitations include the lack of specic
microbiological isolation in pleural uid, a common occurrence in
patients who have previously received antibiotic therapy. Furthermore,
delayed surgical indication is a factor associated with increased morbidity,
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highlighting the need for institutional protocols to guide timely decision-
making (14).
From a therapeutic point of view, the combination of high-ow oxygen
therapy, broad-spectrum antibiotic therapy and surgical management
allowed a favorable recovery in this patient, agreeing with current
evidence that highlights the importance of a multidisciplinary approach
(15). Therapeutic alternatives such as video-assisted thoracoscopy (VATS)
are considered in some centers, however, the choice of open thoracotomy
remains valid in contexts where the disease is extensive and specialized
equipment is limited (16).
This case highlights the need to consider early surgical intervention
in pneumonia complicated by in󰤱uenza A with poor clinical outcome,
as well as the importance of a comprehensive approach to reducing
complications and improving the prognosis in pediatric patients.
4. Conclusions
Pneumonia complicated by inuenza type A in the pediatric
population represents a diagnostic and therapeutic challenge, especially
in cases that progress to severe forms such as pulmonary necrosis. This
clinical case illustrates the importance of a comprehensive approach, in
which early identication of complications and the timely decision to
intervene surgically can be decisive in reducing morbidity and improving
prognosis.
The combination of intensive medical treatment, advanced
ventilatory support, and surgical management led to a favorable outcome
for the patient, reafrming the usefulness of lobectomy as a therapeutic
option in cases refractory to conventional treatment. Evidence shows that
clinical and radiological outcomes must be carefully monitored to avoid
delays in decision-making.
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
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This report emphasizes the need to develop specic management
guidelines for inuenza-associated necrotizing pneumonia in pediatrics,
tailored to the resources available at each institution. It also highlights the
importance of conducting more multicenter studies analyzing predictors
of poor outcomes to optimize interventions for these patients.
The dissemination of clinical experiences such as the one described
here contributes to enriching knowledge about the management
of complicated pneumonias and highlights the importance of
multidisciplinary work in addressing these highly complex pathologies.
5. Abbreviations
NAC: Community-acquired pneumonia
ARDS: Acute Respiratory Distress Syndrome
UCIP: Pediatric Intensive Care Unit
CT: Computed Axial Tomography
PCR: C-Reactive Protein
RSV: Respiratory Syncytial Virus
PPD: Puried Protein Derivative (Tuberculin Test)
FiO2: Fraction of Inspired Oxygen
VATS: Video-Assisted Thoracoscopic Surgery (Video-assisted
Thoracoscopy )
MRSA: Methicillin-Resistant Staphylococcus aureus
(Staphylococcus methicillin -resistant aureus)
6. Contribution of the authors
First author initials: Data collection, case description, literature and
analysis.
Second author initials: Systematic review and case discussion
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Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
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Third author initials: Final case review and updated literature
contribution.
7. Ethics committee approval and consent to
participate in the study
For the publication of this clinical case, all ethical standards
established by the institution and the principles of the Declaration of
Helsinki were adhered to. Informed consent for publication of the case
was granted by the legal representative, who was duly informed about
the nature, objectives, and scope of the presentation. The condentiality
and anonymity of the minor are guaranteed. A copy of the corresponding
informed consent is attached.
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Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Pneumonia complicated by inuenza type A in a pediatric
patient: a case report
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a140
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